We have had many questions regarding bleeding right after embryo transfer or in the
luteal phase. What follows is an attempt to answer one of the chief concerns that IVF
patients have, namely, “What if I have bleeding after my embryo transfer?”
Answer:
The embryo transfer is the most crucial step in the in vitro fertilization
procedure/process. You can have the best quality embryos, but if they are not placed
into the uterus correctly, then pregnancy will not occur. That is why “transfer technique”
is so important. There have been studies showing that pregnancy rates can vary by
physicians within the same group, and this is all because of transfer technique. Once
the disparities between transfer techniques were corrected and unified, the pregnancy
rates became consistent. For this reason, you want to seek out a physician who has a
lot of experience with embryo transfers and comparable good pregnancy rates. If you go
to a clinic that has multiple doctors, ask for the pregnancy rates of each physician or
your particular physician.
For more details regarding post embryo transfer bleeding, pain, and other symptoms,
see “What to Expect After Your Embryo Transfer.”
Bright Red Blood with the Embryo Transfer.
If blood contaminates the endometrial cavity at the time of the transfer, this will kill the
embryos and pregnancy will not occur. The catheter must be placed as gently and
atraumatically as possible. That is an absolute requirement. The endometrium, which is
now in its fullest growth state, thickened from estrogen stimulation, can be easily
scraped which will cause bleeding.
At our centers, we use very soft catheters, very gentle technique, ultrasound guidance,
and mock embryo transfers preceding the cycle to accomplish this. The mock embryo
transfer is especially important so that the physician is not learning the curves of your
canal at the time of transfer but has worked it out prior. This is especially important in
patients whom we consider to have a “tortuous” canal, making it more difficult to insert
the catheter with care.
You should not worry if brown blood or discharge occurs at the time of transfer; it will
usually manifest within the first day or so after the transfer, but not into the mid-luteal
phase or later. That type of bleeding would be from a different source.
There are situations, however, when bleeding can occur but not be ominous.
Sometimes a woman’s cervix will bleed easily from being scraped by the speculum or

irrigation or wiping. This external bleeding will not affect the endometrial cavity as long
as the transfer catheter is not exposed to the blood.
Bleeding After the Transfer
Bleeding that occurs later in the luteal phase, days after the transfer, is very common if
vaginal progesterone is used. 
This has been shown in various studies using Crinone (progesterone vaginal gel), for
example. When using both vaginal and injection progesterone, it is almost 90 percent
possible, but the bleeding tends to occur near the time of the pregnancy test or soon
thereafter. This is probably caused by some erosion occurring on the external cervix.
The exact cause, however, is not clearly understood. It is usually light spotting and can
be anywhere from red to brown. Red is newer blood and brown is old blood. In general,
we tell our patients not to worry about this.
Bleeding that is red and heavy like a period is not a good sign and should not occur if
the hormones progesterone and/or estrogen have not been discontinued. Some
patients will experience slight spotting three to five days after embryo transfer and refer
to this as “implantation bleeding.” Whether or not this is caused by implantation is not
known. Implantation should not cause bleeding.